CPT 25635 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 11 - Office • 23 - Emergency Room |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 25635 |
National average reimbursement for CPT 25635 by major payers:
$623.78
$599.29
$620.57
$773.84
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 25635 | ||||||
United | 25635 | $574.00 | 1114302353 - POINT OF ROCKS SURGERY CENTER, LLC | 464992977 - (MD) POINT OF ROCKS SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $688.00 | 1942245725 - SIERRA PACIFIC SURGERY CENTER LLC, SUMMIT SURGICAL | 954810282 - (CA) SUMMIT SURGICAL | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $82.00 | 1063470730 - ENDOSCOPY CENTER OF ARKANSAS, LLC | 201337002 - (AR) ENDOSCOPY CENTER OF ARKANSAS LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $555.00 | 1184125809 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $91.00 | 1396733945 - EYE LASER & SURGERY CENTER OF COLUMBUS, LLC | 640942234 - (MS) EYE LASER SURGERY CENTER OF COLUMBUS LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $200.00 | 1609882810 - LAGRECA EYE CLINIC PC, THE EYE CLINIC SURGICENTER LAGRECA EYE CLINIC | 320016290 - LAGRECA EYE CLINIC, PC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $418.00 | 1932438553 - MIDDLESEX CENTER FOR ADVANCED ORTHOPEDIC SURGERY | 263528303 - (CT) MIDDLESEX CENTER FOR ADVANCED ORTHOPEDIC SURGERY | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $85.00 | 1487627642 - SURGERY CENTER OF CORAL GABLES LLC, SURGERY CENTER OF CORAL GABLES LLC | 621827649 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $500.00 | 1508342114 - ACTD,LLC, GREEN MOUNTAIN SURGERY CENTER | 472161109 - (VT) ACTDLLC | VT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $226.00 | 1891127981 - PLAZA AMBULATORY SURGERY CENTER LLC | 352480914 - (OR) PLAZA AMBULATORY SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $574.00 | 1265466288 - TAMARAC SURGERY CENTER LLC, THE SURGERY CENTER OF FT LAUDERDALE | 650963549 - (FL) TAMARAC SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $103.00 | 1093214819 - PREMIER SURGICAL CENTER, LLC | 823438730 - (MS) PREMIER SURGICAL CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $71.00 | 1952602609 - GASTROENTEROLOGY & HEPATOLOGY CONSULTANTS, PA, WAKE FOREST ENDOSCOPY CENTER | 562189630 - (NC) GASTROENTEROLOGY AND HEPATOLOGY CONSULTANTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $179.00 | 1528039567 - PREMIER PROFESSIONAL SURGERY CENTER PC, PARKEYE SURGI CENTER | 381894684 - (MI) PARK EYE & SURGI CENTER | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25635 | $190.00 | 1679544050 - TUSCALOOSA SURGICAL CENTER LP, TUSCALOOSA SUR | 630974161 - (AL) TUSCALOOSA SURGICAL CENTER LP | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 25635 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25635 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 25635 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 25624-CPT | Moderate | Close Carpal Scaphoid W Manip |
| 25628-CPT | Moderate | Open Carpal Scaphoid W/Wo Fix |
| 25630-CPT | Moderate | Treatment Of Closed Carpal Bone Fracture (Excluding Carpal Scaphoid (Navicular)); Without Manipulation, Each B |
| 25635-CPT | Moderate | Treatment Of Closed Carpal Bone Fracture (Excluding Carpal Scaphoid (Navicular)); With Manipulation, Each Bone |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25635. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25635 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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